Visual Aid For Identifying Suture Limbs Arthroscopically

ABSTRACT

A flexible suture for coupling tissue includes a first suture portion extending to a first end and a second suture portion extending to a second end. A plurality of braided strands form the first and second suture portions. An identifier characteristic is formed into the plurality of braided strands. The identifier characteristic extends from the first end of the first suture portion to the second end of the second suture portion, and the identifier characteristic distinguishes the first suture portion from the second suture portion.

FIELD

The present disclosure relates to suture constructions and, moreparticularly, to suture loop constructions containing visual aids foridentifying suture limbs arthroscopically.

BACKGROUND

This section provides background information related to the presentdisclosure which is not necessarily prior art.

Arthroscopic surgery is performed using an arthroscope, a type ofendoscope that is inserted into the joint through a small incision. Thesurgery is performed through portals (or cannulas) in the body throughwhich the endoscope and tools are inserted. Often the surgeon is workingin small, tight areas.

It is common for surgeons to use sutures to secure soft tissues to bone,bone to bone, and tissue to tissue. Often when working in the smalltight area, the surgeon may have difficulty distinguishing the suturelimbs or tying the suture limbs without moving the tissue or bone.

SUMMARY

This section provides a general summary of the disclosure, and is not acomprehensive disclosure of its full scope or all of its features.

The present teachings provide for a flexible suture for coupling tissue.The flexible suture includes a first suture portion extending to a firstend and a second suture portion extending to a second end. A pluralityof braided strands that form the first and second suture portions. Anidentifier characteristic is formed into the plurality of braidedstrands. The identifier characteristic extends from the first end of thefirst suture portion to the second end of the second suture portion, andthe identifier characteristic distinguishes the first suture portionfrom the second suture portion.

The present teachings also provide for a flexible suture for couplingtissue that includes a first suture limb extending to a first end and asecond suture limb extending to a second end. A plurality of braidedstrands that form the first and second suture limbs. A first structuralidentifier characteristic is formed into the plurality of braidedstrands of the first suture limb. A second structural identifiercharacteristic is formed into the plurality of braided strands of thesecond suture limb. The first and second structural identifiersdifferentiate the structure of the first suture limb from the structureof the second suture limb.

The present teachings also provide for a flexible suture for couplingtissue that includes a first suture limb extending to a first end and asecond suture limb extending to a second end. A plurality of braidedstrands that form the first and second suture limbs. One of the firstand second suture limbs includes a dyed portion.

The present teachings also provide for flexible suture for couplingtissue that includes a first suture limb extending to a first end and asecond suture limb extending to a second end. A plurality of braidedstrands that form the first and second suture limbs. The first suturelimb forms a braided cylinder, and the second suture limb forms abraided flat ribbon.

A flexible suture for coupling tissue that includes a first suturesection that extends from a first end to a second end. A second suturesection that extends from a third end to a fourth end. A plurality ofbraided strands that form the first and second suture sections. Anidentifier characteristic that is formed into the plurality of braidedstrands. The identifier characteristic extends from the first end to thesecond end of the first suture section and from the third end to thefourth end of the second suture section, and the identifiercharacteristic distinguishes the first suture limb from the secondsuture limb. A coupler attaches the first suture section to the secondsuture section.

Further areas of applicability will become apparent from the descriptionprovided herein. The description and specific examples in this summaryare intended for purposes of illustration only and are not intended tolimit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustrative purposes only ofselected embodiments and not all possible implementations, and are notintended to limit the scope of the present disclosure.

FIG. 1A is a side view of a suture construct according to the presentdisclosure;

FIG. 1B is a perspective view of the suture construct of FIG. 1Aarranged in an anchor device;

FIG. 2 is a cross-sectional view taken along line 2-2 of FIG. 1A;

FIG. 3 is an environmental view of the suture securing a portion of softtissue to a portion of bone according to the present disclosure;

FIGS. 4A-C are environmental views of the suture repairing a tear insoft tissue according to the present disclosure;

FIG. 5A is a side view of a second embodiment of a suture constructaccording to the present disclosure;

FIG. 5B is a perspective view of the suture construct of FIG. 5Aarranged in the anchor device;

FIG. 5C is a second side view of the suture construct of FIG. 5A;

FIG. 5D is a perspective view of the suture construct of FIG. 5Carranged in the anchor device;

FIGS. 6A-B are side views of a third embodiment of a suture constructaccording to the present disclosure;

FIG. 7 is a side view of a fourth embodiment of a suture constructaccording to the present disclosure;

FIG. 8 is a side view of a fifth embodiment of a suture constructaccording to the present disclosure;

FIG. 9 is a perspective view of a sixth embodiment of a suture constructarranged in the anchor device according to the present disclosure;

FIGS. 10A-B are side views of a seventh embodiment of a suture constructaccording to the present disclosure;

FIG. 11 is a side view of an eighth embodiment of a suture constructaccording to the present disclosure;

FIGS. 12A-C are side views of a ninth embodiment of a suture constructarranged in the anchor device according to the present disclosure;

FIG. 13 is a perspective view of a tenth embodiment of a sutureconstruct according to the present disclosure; and

FIGS. 14-22 illustrate formation of a tail of a knotless suture anchordevice according to the present teachings.

Corresponding reference numerals indicate corresponding parts throughoutthe several views of the drawings.

DETAILED DESCRIPTION

Example embodiments will now be described more fully with reference tothe accompanying drawings.

With initial reference to FIG. 1A, a suture construct is generallyillustrated at reference numeral 10. The suture construct 10 generallyincludes a first terminal end 14 and a second terminal end 18 and mayinclude an identification characteristic such as a tracer 22 to identifythe suture 10. The tracer 22 may extend from the first terminal end 14to the second terminal end 18 of the suture construct 10. As shown inmore detail in FIG. 2, the suture construct 10 may include an outer wall26 formed from a plurality of strands 30 braided together. Each strand30 may further include a plurality of fibers 34 braided together to formthe strand 30. The tracer 22 may be one or more of the plurality ofstrands 30 or fibers 34.

When the tracer 22 extends from the first terminal end 14 to the secondterminal end 18 of the suture construct 10, the suture construct 10 iseasier to form because it can be manufactured in a single continuousstep. There is no need to stop the machine during manufacturing to addor subtract any of the strands that are braided into the suture.

The suture construct 10 and tracer 22 may be made of any suitableflexible material or member, and need not be made of a suture. Thesuture construct 10 may also be made of a variety of differentmaterials. When the suture construct 10 and tracer 22 are made ofsutures, any suitable suture can be used.

For example, the braided suture may be a 16-strand hollow-core suture(see FIG. 2). In this example, 16 strands are braided together to formthe outer wall 26, leaving a hollow passage 28 through the centerextending from the first terminal end 14 to the second terminal end 18.Each strand 30 is formed from the plurality of fibers 34 that arebraided together. The tracer 22 may be at least one strand or aplurality of strands in the suture construct 10. Any suitable braidedsuture can be used.

The suture construct 10 and tracer 22 may be of a variety of differentmaterials. For example, the strands 30 of suture construct 10 may be ofa polyethylene material that is substantially translucent or colorless.The tracer 22 may be of a polyester or nylon material that is eitherwhite or dyed a contrasting color to identify the tracer 22 in thesuture construct 10. The tracer 22 assists the surgeon indifferentiating between suture strands with the trace and suture strandswithout the trace. The tracer 22 may be modified from the first terminalend 14 to the second terminal end 18 of the suture construct 10 toassist the surgeon in distinguishing the first end 14 from the second18.

With additional reference to FIG. 1B, sutures generally are manufacturedin a spool and then cut to a specific length (for example only, 38inches) to form the suture construct 10. Once cut to length, the sutureconstruct 10 may be attached to an exemplary anchor 38. While a rigidanchor is illustrated, the surgeon can use any known anchor including aflexible anchor. The suture construct 10 may further include a firstsuture limb 42 adjacent to the first terminal end 14 and a second suturelimb 46 adjacent to the second terminal end 18. The length of the firstsuture limb 42 may be equivalent to half the length of the sutureconstruct 10 (for example only, 19 inches), equivalent to a portion thatis less than half the length of the suture construct 10, or equivalentto a portion that is more than half the length of the suture construct10. To help distinguish between the first suture limb 42 and the secondsuture limb 46, which can be particularly helpful for a surgeon duringsurgery, the first suture limb 42 and the second suture limb 46 can beprovided with different colors, patterns, or designs, for example.Accordingly, when the suture is threaded through the eyelet of theanchor 38, the two limbs 42 and 46 may be distinguished, helping toidentify their direction of travel.

In the embodiment of FIGS. 1A and B, the first suture limb 42 isdistinguished from the second suture limb 46 in the number of picks perinch (PPI), or tightness, of the tracer 22 braided into the suture. ThePPI is the number of traces visible per inch along the suture. Forexample, the PPI of the tracer 22 in the first suture limb 42 may be 30PPI; whereas, the PPI of the tracer 22 in the second suture limb 46 maybe 60 PPI, or twice as tight as the first suture limb 42. Thisdifference is apparent by visual inspection because the colored tracer22 will appear twice as often on the second suture limb 46 as it does onthe first suture limb 42.

Now referring to FIG. 3, the suture construct 10 can be used to attach aportion of soft tissue 50 to bone 54. The suture construct 10 isthreaded through the anchor 38. The anchor 38 is secured to the bone 54by engaging a plurality of threads 58 on the anchor 38 into the bone 54using an anchor implant or driving tool (not pictured). The first suturelimb 42 may be passed through the soft tissue 50, becoming a post. Thesecond suture limb 46 is passed around the outside of the soft tissue 50and is knotted to the post 42. The suture limb 42 passing through thesoft tissue 50 is used as the post when securing the first and secondsuture limbs 42, 46, because it is desirable for there to be minimalmovement of the suture limb in the soft tissue 50. By knowing which endof the suture is the post and which end is to be knotted to the post,via the tracer 22, the surgeon can perform the procedure more quicklyand efficiently during arthroscopic surgery.

Now referring to FIGS. 4A-C, the suture construct 10 may be used torepair a tear 62 in soft tissue 66. The suture construct 10 is threadedthrough the soft tissue, the first suture limb 42 on a first side of thetear 62 and the second suture limb 46 on an opposite, second side of thetear 62 (FIG. 4A). One of the suture limbs, for example only, the firstsuture limb 42, is determined to function as the post. The other suturelimb, for example only, the second suture limb 46, is knotted around thepost 42 (FIG. 4B). The knot is then pulled tight closing the tear 62 inthe soft tissue 66 (FIG. 4C). Again, by knowing which end of the sutureis the post and which end is to be knotted to the post, via the tracer22, the surgeon can perform the procedure more quickly and efficientlyduring arthroscopic surgery.

Now referring to FIGS. 5A-D, a second embodiment of a suture construct100 is illustrated. The suture construct 100 generally includes a firstterminal end 104 and a second terminal end 108 and may include anidentifier characteristic such as a color coating 112 on only a portionof the suture 100. The suture construct 100 may include the outer wall26 formed from the plurality of strands 30 braided together (FIG. 2).Each strand 30 may further include the plurality of fibers 34 braidedtogether to form the strand 30. Further, the suture construct 100 mayalso be of a monofilament construct (not shown). The suture construct100 may be divided into two portions, a first suture limb 116 adjacentto the first terminal end 104 and a second suture limb 120 adjacent tothe second terminal end 108, that may be distinguished by the colorcoating 112.

The plurality of fibers 34 may be of an all-white polyethylene materialthat is braided to form the plurality of strands 30. The second suturelimb 120 may be coated with a dye or other material that is known toadhere to the polyethylene material. The dye or other material may be ofa contrasting color to the all-white polyethylene and therefore mayprovide the color coating 112 on a portion of the suture construct 100.The color coating 112 may be applied to the entire second suture limb120 (FIG. 5A) or may be applied in specific locations of the secondsuture limb 120 (FIG. 5C), distinguishing the second suture limb 120from the first suture limb 116. The differences between the first suturelimb 116 and the second suture limb 120 become more apparent when thesuture construct 100 is threaded through the anchor 38. The differencesin appearance help to identify the direction of travel and correspondingends of each suture limb 116, 120.

The plurality of fibers 34 may also contain a material known to beradiopaque, for example barium sulfate, that is braided to form theplurality of strands 30. A radiopaque material is known in the art to bevisible in x-ray images and to the naked eye. The second suture limb 120may be coated with a radiopaque material such as barium sulfate. Theradiopaque material may be of a contrasting color to the plurality ofstrands 30 and therefore may provide the color coating 112 on a portionof the suture construct 100. The color coating 112 may be applied to theentire second suture limb 120 (FIG. 5A) or may be applied in specificlocations of the second suture limb 120 (FIG. 5C), distinguishing thesecond suture limb 120 from the first suture limb 116.

Now referring to FIGS. 6A-B, a third embodiment of a suture construct200 is illustrated. The suture construct 200 generally includes a firstsuture limb 204 and a second suture limb 208 and may include anidentifier characteristic such as a tracer 210 on a portion of thesuture 200. The tracer 210 may extend the entire length of the suturelimb 204. The suture construct 200 may include the outer wall 26 formedfrom the plurality of strands 30 braided together (FIG. 2). Each strand30 may further include the plurality of fibers 34 braided together toform the strand 30.

The first suture limb 204 may be connected to the second suture limb 208to form a continuous suture construct 200. The first suture limb 204 mayinclude a first terminal end 212 and a second terminal end 216, and thesecond suture limb 208 may include a first terminal end 220 and a secondterminal end 224. The first and second suture limbs 204, 208 may be tiedtogether with a knot, adhered or epoxied together, locked together bypassing each strand through the opposite strand, or fixed together byany means known in the art. When passing the strands through oppositeends, the suture from one end is passed between the braided strands,along the hollow core, and out through the braided strand or retained inthe hollow core.

The second end 216 of the first suture limb 204 may be locked within thesecond suture limb 208, and the second end 224 of the second suture limb208 may be locked within the first suture limb 204 (FIG. 6B). The firstsuture limb 204 may include a first aperture 228, and the second suturelimb 208 may include a second aperture 232. The first and secondapertures 228, 232 are formed during the braiding process as looseportions between pairs of strands defining the suture. The secondterminal end 216 is passed through the second aperture 232 and into thehollow passage 28 of the 16-strand hollow-core suture. The secondterminal end 224 is passed through the first aperture 228 and into thehollow passage 28 of the 16-strand hollow-core suture. When tightened,the second terminal end 216 of the first suture limb 204 and the secondterminal end 224 of the second suture limb 208 resist the reversemovement. It is envisioned that the second terminal end 216 of the firstsuture limb 204 and the second terminal end 224 of the second suturelimb 208 may be passed through the hollow passage 28 several timesthrough multiple apertures in the first and second suture limbs 204,208. Further, the second terminal end 216 of the first suture limb 204and the second terminal end 224 of the second suture limb 208 may beretained in the hollow passage 28 or passed out through the braidedstrand.

The first and second suture limbs 204, 208 may be of different colors orsizes to assist the surgeon in differentiating between the differentlimbs 204, 208. For example, the first suture limb 204 may include thetracer 22 extending from the first end 212 to the second end 216 andbeing of a polyethylene or nylon material that has been dyed black. Thesecond suture limb 208 may not include the tracer 22 or may include thetracer 22 being of a contrasting color such as red. The first and secondsuture limbs 204, 208 may also be of different sizes or diameters. Forexample, the first suture limb 204 may be braided tighter than thesecond suture limb 208, or vice versa. The second suture limb 208 mayhave a larger diameter than the first suture limb 204, and the firstsuture limb 204 may have a higher stiffness than the second suture limb208, or vice versa.

Now referring to FIG. 7, a fourth embodiment of a suture construct 300is illustrated. The suture construct 300 generally includes a firstsuture limb 304 adjacent to a first terminal end 308 and a second suturelimb 312 adjacent to a second terminal end 316. The suture construct 300may further include an identifier characteristic such as a tracer 320 ona portion of the suture 300. The tracer 320 may extend from the firstterminal end 308 to the second terminal end 316. The suture construct300 may include the outer wall 26 formed from the plurality of strands30 braided together (FIG. 2). Each strand 30 may further include theplurality of fibers 34 braided together to form the strand 30.

The tracer 320 may be one or more of the plurality of strands 30 orfibers 34 braided into the suture construct 300 similar to that of theembodiment illustrated in FIGS. 1 a-b. The suture construct 300 andtracer 320 can be made of any suitable flexible material or member, andneed not be made of a suture. When the suture construct 300 and tracer320 are made of sutures, any suitable suture can be used.

The suture construct 300 and tracer 320 may be of a variety of differentmaterials. For example, the strands 30 of suture construct 300 may be ofa polyethylene material that is substantially translucent or colorlessand may also include a polyester or nylon material that is white incolor. The tracer 320 may be of a polyester or nylon material that iseither white or dyed a contrasting color to identify the tracer 320 inthe suture construct 300. The tracer 320 assists the surgeon indifferentiating between suture strands with the trace and suture strandswithout the trace.

The tracer 320 may be braided so that it is visual to an observer for afirst portion 324 of the suture construct 300. The first portion 324 maybe the same length as, and correspond to, the first suture limb 304. Thetracer 320 then may be braided in the hollow passage 28 so that it isnot visible to the observer for a second portion 328 of the sutureconstruct 300. The second portion 328 may be the same length as, andcorrespond to, the second suture limb 312. After the second portion 328the tracer 320 may be braided so that it is visual to the observeragain. This pattern may be followed for the length of several sutureconstructs 300 during manufacturing and then cut to specified sutureconstruct 300 lengths (for example only, 38 inches) at a later time.

Now referring to FIG. 8, a fifth embodiment of a suture construct 400 isillustrated. The suture construct 400 generally includes a first suturelimb 404 adjacent to a first terminal end 408 and a second suture limb412 adjacent to a second terminal end 416. The suture construct mayfurther include an identifier characteristic such as a tracer 420 on aportion of the suture 400. The tracer 420 may extend from the firstterminal end 408 to the second terminal end 416 of the suture construct400. The suture construct 400 may include the outer wall 26 formed fromthe plurality of strands 30 braided together (FIG. 2). Each strand 30may further include the plurality of fibers 34 braided together to formthe strand 30.

The tracer 420 may be one or more of the plurality of strands 30 orfibers 34 braided into the suture construct 400 similar to that of theembodiment illustrated in FIGS. 1A-B. The suture construct 400 andtracer 420 can be made of any suitable flexible material or member, andneed not be made of a suture. When the suture construct 400 and tracer420 are made of sutures, any suitable suture can be used.

The suture construct 400 and tracer 420 may be of a variety of differentmaterials. For example, the strands 30 of suture construct 400 may be ofa polyethylene material that is substantially translucent or colorlessor white in color. The tracer 420 may be of a polyester or nylonmaterial that is white in color. The tracer 420 assists the surgeon indifferentiating between suture strands with the trace and suture strandswithout the trace.

The tracer 420 may be braided into the suture construct 400 such that itis visible to the observer. After manufacturing of the suture construct400 is complete, a first portion 424 of the suture construct 400 may bedipped in a dye solution of a contrasting color to dye the tracer 420braided into the first portion 424. The first portion 424 may be thesame length as the first suture limb 404. The dye adheres to thepolyester or nylon material of the tracer 420 and does not adhere to thepolyethylene fibers in the suture construct 420. Only the first portion424 of the suture construct 400 is dyed a contrasting color so that thefirst suture limb 404 is differentiated from the second suture limb 412.By braiding a white tracer 420 into the suture construct 400 duringmanufacturing and dying the tracer 420 at a later time, a plurality ofsuture constructs 400 can be manufactured at one time and later be dyeddifferent colors.

Now referring to FIG. 9, a sixth embodiment of a suture construct 500 isillustrated. The suture construct 500 generally includes a first suturelimb 504 and a second suture limb 508. The suture construct 500 mayinclude an identifier characteristic such as a tracer (not pictured)extending the entire length of the suture construct 500 as discussed inprevious embodiments, but inclusion of the tracer in the sutureconstruct 500 is not necessary for the sixth embodiment. The sutureconstruct 500 may be the 16-strand hollow-core suture and may includethe outer wall 26 formed from the plurality of strands 30 braidedtogether (FIG. 2). Each strand 30 may further include the plurality offibers 34 braided together to form the strand 30. The suture construct500 may further be threaded through an eyelet of an anchor 512.

The suture construct 500 may be braided similar to that of theembodiment illustrated in FIGS. 1A-B. The suture construct 500 can bemade of any suitable flexible material or member, and need not be madeof a suture. When the suture construct 500 is made of sutures, anysuitable suture can be used. For example, the fibers 34 forming thestrands 30 of suture construct 500 may be of a polyethylene materialthat is substantially translucent or colorless or white in color.

The suture construct 500 may include a structural identifiercharacteristic, such as knots, extending the entire length of the sutureconstruct 500. One of the first and second suture limbs 504, 508 mayinclude knots 516 in specific locations along the suture limb, forexample the second suture limb 508, as illustrated. The knots 516 alongthe second suture limb 508 may assist the surgeon in differentiatingbetween the first suture limb 504 and the second suture limb 508 and mayhelp to identify the direction of travel of each suture limb 504, 508.

Once the suture construct 500 is braided as discussed in previousembodiments, the suture construct 500 may be cut to length. The sutureconstruct 500 may be threaded through the eyelet of the anchor 512.Preformed knots 516 may be placed in specific locations along either thefirst suture limb 504 or the second suture limb 508 (for example only,the second suture limb 508). The anchor 512 is secured in the bone 54,and the first suture limb 504 without the knots 516 is threaded throughthe soft tissue 50 (see also FIG. 3). The first suture limb 504 becomesthe post. The second suture limb 508 is passed around the outside of thesoft tissue 50 and is knotted to the post 504. The first suture limb 504passing through the soft tissue 50 is used as the post when securing thefirst and second suture limbs 504,508, because it is desirable for thereto be minimal movement of the suture limb in the soft tissue 50.Further, the first suture limb 504 is desirable to pass through the softtissue 50 because the first suture limb 504 does not contain knots 516that may become caught or do more damage or tearing to the soft tissue50.

Now referring to FIGS. 10A-B, a seventh embodiment of a suture construct600 is illustrated. The suture construct 600 generally includes a firstsuture limb 604 adjacent to a first terminal end 608 and a second suturelimb 612 adjacent to a second terminal end 616. The suture construct 600may further include an identifier characteristic such as a tracer 620 ona portion of the suture 600. The tracer 620 may extend from the firstterminal end 608 to the second terminal end 616. The suture construct600 may be the 16-strand hollow-core suture and may include the outerwall 26 formed from the plurality of strands 30 braided together (FIG.2). Each strand 30 may further include the plurality of fibers 34braided together to form the strand 30.

The tracer 620 may be one or more of the plurality of strands 30 orfibers 34 braided into the suture construct 600. The suture construct600 and tracer 620 can be made of any suitable flexible material ormember, and need not be made of a suture. When the suture construct 600and tracer 620 are made of sutures, any suitable suture can be used.

The suture construct 600 and tracer 620 may be of a variety of differentmaterials. For example, the strands 30 of suture construct 600 may be ofa polyethylene material that is substantially translucent or colorlessor white in color. The tracer 620 may be of a polyester or nylonmaterial that is a contrasting color. The tracer 620 assists the surgeonin differentiating between suture strands with the trace and suturestrands without the trace.

Each suture construct 600 may be cut from a suture group 624. The suturegroup 624 may be manufactured by braiding 16 strands 30 (of theplurality of fibers 34) together for a specific length (for exampleonly, 1 inch) and then splitting the strands 30 into a first group 628and a second group 632 of 8 strands each. One of the first group 628 andthe second group 632 contains the plurality of strands 30 of the tracer620. Each group of strands 628, 632 is individually braided for aspecific length (for example only, 38 inches). The 16 strands 30 arethen braided together. This pattern is repeated several times to formthe suture group 624. The resulting suture group 624 is cut at a firstportion 636 where the 16 strands 30 are braided together and at a secondportion 640 along the first group 628 and the second group 632 aspecific length (for example only, 19 inches) from where the 16 strandssplit into two groups of 8 strands each. Once cut, each suture construct600 is in a condition ready for use.

Now referring to FIG. 11, an eighth embodiment of a suture construct 700is illustrated. The suture construct 700 generally includes a firstsuture limb 704 adjacent to a first terminal end 708 and a second suturelimb 712 adjacent to a second terminal end 716. The suture construct 700may further include an identification characteristic such as a tracer720 on a portion of the suture 700. The tracer 720 may extend from thefirst terminal end 708 to the second terminal end 716. The sutureconstruct 700 may be the 16-strand hollow-core suture and may includethe outer wall 26 formed from the plurality of strands 30 braidedtogether (FIG. 2). Each strand 30 may further include the plurality offibers 34 braided together to form the strand 30.

The suture construct 700 and tracer 720 can be made of any suitableflexible material or member, and need not be made of a suture. When thesuture construct 700 and tracer 720 are made of sutures, any suitablesuture can be used. For example, the strands 30 of suture construct 700may be of a polyethylene material that is substantially translucent orcolorless or white in color. The tracer 720 may be of a polyester ornylon material that is a contrasting color. The tracer 720 assists thesurgeon in differentiating between suture strands with the trace andsuture strands without the trace.

The tracer 720 may be sewn in to the suture construct 700 after thesuture construct 700 has been braided into the 16-strand hollow-coresuture as described above. The tracer 720 may only be sewn into aportion of the suture construct 700 corresponding to the second suturelimb 712 to differentiate the second suture limb 712 from the firstsuture limb 704. The tracer may also be sewn into the portion of thesuture construct 700 corresponding to the second suture limb 712 so thatit is visible on the second suture limb 712 and may be sewn into thehollow passage 28 of the suture construct 700 over a portioncorresponding to the first suture limb 704 so that it is not visible butextends the entire length of the suture construct 10.

Now referring to FIGS. 12A-C, a ninth embodiment of a suture construct800 is illustrated. The suture construct 800 generally includes a firstsuture limb 804 and a second suture limb 808. The suture construct 800may include an identifier characteristic such as a tracer (not pictured)extending the entire length of the suture construct 800 as discussed inprevious embodiments, but inclusion of the tracer in the sutureconstruct 800 is not necessary for the ninth embodiment. The sutureconstruct 800 may be the 16-strand hollow-core suture and may includethe outer wall 26 formed from the plurality of strands 30 braidedtogether (FIG. 2). Each strand 30 may further include the plurality offibers 34 braided together to form the strand 30. One of the firstsuture limb 804 and the second suture limb 808 may include a structuralidentifier, such as a loop or a bifurcation, to assist the surgeon indifferentiating between the first and second suture limbs 804, 808.Further, the suture construct 800 may include a structuralidentification characteristic extending the entire length of the suture800 that differentiates a first suture limb 804 from a second suturelimb 808.

Referring specifically to FIG. 12A, once the suture construct 800 isbraided according to previous embodiments, the suture construct 800 maybe cut to length. The suture construct 800 may then be threaded throughthe eyelet of an anchor 812. The second suture limb 808 may be loopedback to the eyelet of the anchor 812 and secured in order to form a loopfor identification and ability to manipulate. The anchor 812 is securedin the bone 54, and the second suture limb 808 with the loop is passedthrough the soft tissue 50 (see also FIG. 3). The second suture limb 808becomes the post. The first suture limb 804 is passed around the outsideof the soft tissue 50 and is knotted to the post 808. The second suturelimb 808 passing through the soft tissue 50 is used as the post whensecuring the first and second suture limbs 804, 808, because it isdesirable for there to be minimal movement of the suture limb in thesoft tissue 50 and the loop in the second suture limb 808 is easy tograb with a tool arthroscopically.

Referring specifically to FIG. 12B, once the suture construct 800 isbraided according to previous embodiments, the suture construct 800 maybe cut to length. The suture construct 800 may be threaded through theeyelet of the anchor 812. A loop 816 may be secured along the length ofthe second suture limb 808 for identification and manipulation. The loop816 may be secured to the suture limb 808 similarly to the lockingmethod discussed in the third embodiment 200. The second suture limb 808may include a first aperture 820 and a second aperture 824. The firstand second apertures 820, 824 are formed during the braiding process asloose portions between pairs of fibers defining the suture. A first end828 of the loop 816 is passed through the first aperture 820 and intothe hollow passage 28 of the 16-strand hollow-core suture. A second end832 is passed through the second aperture 824 and into the hollowpassage 28 of the 16-strand hollow-core suture. When tightened, thefirst end 828 and the second end 832 resist reverse movement and theloop 816 remains secured to the second suture limb 808.

The anchor 812 is secured in the bone 54, and the second suture limb 808with the loop 816 is passed through the soft tissue 50 arthroscopically(see also FIG. 3). The second suture limb 808 becomes the post. Thefirst suture limb 804 is passed around the outside of the soft tissue 50and is knotted to the loop 816 on the post 808. The second suture limb808 passing through the soft tissue 50 is used as the post when securingthe first and second suture limbs 804, 808, because it is desirable forthere to be minimal movement of the suture limb in the soft tissue 50and the loop in the second suture limb 808 is easy to grab with a toolarthroscopically.

Referring specifically to FIG. 12C, once the suture construct 800 isbraided according to previous embodiments, the suture construct 800 maybe cut to length. The suture construct 800 may be threaded through theeyelet of the anchor 812. A bifurcation 836 may be formed along thelength of the second suture limb 808 for identification andmanipulation. The bifurcation 836 may be formed during the braidingprocess as a loose portion between pairs of fibers defining the suture.

The anchor 812 is secured in the bone 54, and the second suture limb 808with the bifurcation 836 is passed through the soft tissue 50arthroscopically (see also FIG. 3). The second suture limb 808 becomesthe post. The first suture limb 804 is passed around the outside of thesoft tissue 50 and is knotted to the bifurcation 836 on the post 808.The second suture limb 808 passing through the soft tissue 50 is used asthe post when securing the first and second suture limbs 804, 808,because it is desirable for there to be minimal movement of the suturelimb in the soft tissue 50, and the bifurcation 836 in the second suturelimb 808 is easy to grab with a tool arthroscopically.

During the process to secure the first suture limb 804 to the secondsuture limb 808, the first suture limb 804 is passed through thebifurcation 836 in the second suture limb 808. The strands 30 of fibers34 in the second suture limb 808 may be tightened applying pressure tothe first suture limb 804. When tightened, the first suture limb 804resists reverse movement and may be knotted around the second suturelimb 808.

Now referring to FIG. 13, a tenth embodiment of a suture construct 900is illustrated. The suture construct 900 generally includes a firstsuture limb 904 adjacent to a first terminal end 908 and a second suturelimb 912 adjacent to a second terminal end 916. The suture construct 900may include an identifier characteristic such as a tracer (not pictured)extending the entire length of the suture construct 900 as discussed inprevious embodiments, but inclusion of the tracer in the sutureconstruct 900 is not necessary for the tenth embodiment. The sutureconstruct 900 can be made of any suitable flexible material or member,and need not be made of a suture. When the suture construct 900 is madeof sutures, any suitable suture can be used. For example, the strands 30of suture construct 900 may be of a polyethylene material that issubstantially translucent, colorless, or white in color.

The suture construct 900 may include an identification characteristic ona plurality of portions to assist the surgeon in identifying the firstterminal end 908 and the second terminal end 916. A first portion 920that may correspond to the first suture limb 904 may be the 16-strandhollow-core suture discussed previously and may include the outer wall26 formed from the plurality of strands 30 braided together (FIG. 2).Each strand 30 may further include the plurality of fibers 34 braidedtogether to form the strand 30. A second portion 924 that may correspondto the second suture limb 912 may be a 16-strand flat braided ribbonconstruct formed from the plurality of strands 30 braided together. Eachstrand 30 may further include the plurality of fibers 34 braidedtogether to form the strand 30. The round or cylindrical shape of thefirst portion 920 is distinguished from the flat shape of the secondportion 924 both by touch and sight to assist the surgeon indistinguishing the first suture limb 904 from the second suture limb912.

During manufacture of the first portion 920 of the suture construct 900,each of the 16 strands 30 is braided around the remainder of the strands30 to form the cylindrical shape. During manufacture of the secondportion 924 of the suture construct 900, the strands 30 are braidedhorizontally back and forth to create a flat braid. While manufacturingthe suture construct 900, the different braid patterns are alternated toform a single long suture group that can then be cut to appropriatesuture lengths (for example only, 38 inches).

With additional reference to FIGS. 14-22, a method for forming a suturetail 12′, or any other suture strand in which it would be advantageousto distinguish between two different suture portions, will now bedescribed. With initial reference to FIG. 14, a second portion 68′ ofthe suture tail 12′ is illustrated. The second portion 68′ includes afirst end 68A′ and a second end 68B′. Second end 18′ of the suture tail12′ is at the second end 68B′ of the second portion 68′. As illustratedin FIG. 15, a threader, such as the threader 92′ or any suitablethreading device, is inserted through a first area of the second portion68′ of the suture tail 12′ to define a first tail sleeve 68C′. Thethreader 92′ is also inserted through a second area to define a secondtail sleeve 68D′. The second tail sleeve 68D′ is closer to the first end68A′ than the first tail sleeve 68C′.

With the threader 92′ extending through each of the first tail sleeve68C′ and the second tail sleeve 68D′, the first end 68A′ is insertedinto the threader 92′ and grasped by the threader 92′. The threader 92′is then withdrawn through the second tail sleeve 68D′ and the first tailsleeve 68C′ in order to draw the first end 68A′ through the second tailsleeve 68D′ and into the first tail sleeve 68C′, as illustrated in FIG.16. Therefore, the second portion 68′ defines a loop 68E′. Again, sincethe tail 16′ is made from braided fibers, the first tail sleeve 68C′ andthe second tail sleeve 68D′ are formed by a passage formed by thebraided fibers that extends from the first end 66A′ to the second end66B′. Ends of each of the first tail sleeve 68C′ and the second tailsleeve 68D′ are formed by openings in the braided fibers.

With additional reference to FIG. 17, the first portion 66′ of thesuture tail 12′ includes a first end 66A′ that is opposite to a secondend 66B′. The threader 92′ is inserted through the first portion 66′ ator proximate to the second end 66B′ to define a third tail sleeve 66C′in the first portion 66′. The second end 68B′ of the second portion 68′is inserted through the threader 92′, and the threader 92′ is withdrawnthrough the third tail sleeve 66C′ in order to draw the second portion68′ into the third tail sleeve 66C′, as illustrated in FIG. 18.

With additional reference to FIG. 19, the first end 66A′ of the firstportion 66′ is inserted through the loop 68E′ of the second portion 68′,and the first end 66A′ is pulled, which pulls the third tail sleeve 66C′over and past the first tail sleeve 68C′ and onto the second tail sleeve68D′, as illustrated in FIG. 20. With additional reference to FIG. 21,an excess area of the second portion 68′ proximate to the first end 68A′is cut from a remainder of the second portion 68′. As illustrated inFIG. 22, the first portion 66′ and the second portion 68′ are thenpulled apart to strengthen the connection between the first portion 66′and the second portion 68′, and thereby form the suture tail 12′ of theknotless suture anchor device 10′.

To make it easier for a surgeon to distinguish between the first portion66′ and the second portion 68′ of the suture tail 12′, the first portion66′ and the second portion 68′ can be configured in any suitable mannerto facilitate distinction therebetween, such as visual distinctiontherebetween. For example, the first portion 66′ and the second portion68′ can include or consist of different colors, and/or different designpatterns, and/or any of the tracers 22, 210, 320, 420, 620, 720described herein configured in any suitable manner to distinguish thefirst and second portions 66′ and 68′ from one another. The first andsecond portions 66′ and 68′ can also have different thicknesses orweights. The foregoing description of the embodiments has been providedfor purposes of illustration and description. It is not intended to beexhaustive or to limit the disclosure. Individual elements or featuresof a particular embodiment are generally not limited to that particularembodiment, but, where applicable, are interchangeable and can be usedin a selected embodiment, even if not specifically shown or described.The same may also be varied in many ways. Such variations are not to beregarded as a departure from the disclosure, and all such modificationsare intended to be included within the scope of the disclosure.

What is claimed is:
 1. A flexible suture for coupling tissue comprising:a first suture portion extending to a first end and a second sutureportion extending to a second end; a plurality of braided strandsforming the first and second suture portions; and an identifiercharacteristic formed into the plurality of braided strands, wherein theidentifier characteristic extends from the first end of the first sutureportion to the second end of the second suture portion, and theidentifier characteristic distinguishes the first suture portion fromthe second suture portion.
 2. The flexible suture of claim 1, whereinthe identifier characteristic is a colored tracer extending from thefirst end of the first suture portion to the second end of the secondsuture portion.
 3. The flexible suture of claim 2, further comprising adifference in a pick count of the colored tracer on the first sutureportion from the second suture portion.
 4. The flexible suture of claim2, wherein the colored tracer is braided on the exterior of the flexiblesuture on the first suture portion, and the colored tracer is positionedon the interior of the suture on the second suture portion.
 5. Theflexible suture of claim 2, further comprising a first braided portionhaving all of the plurality of braided strands and second and thirdbraided portions having fewer than all of the plurality of braidedstrands.
 6. The flexible suture of claim 5, wherein the colored traceris included in the first braided portion and only one of the second andthird braided portions.
 7. The flexible suture of claim 2, wherein thecolored tracer is sewn in specific points along the portion of theflexible suture.
 8. The flexible suture of claim 2, wherein the coloredtracer is of a material that accepts dye or color to contrast the tracerfrom strands in the flexible suture.
 9. The flexible suture of claim 1,wherein the flexible suture including the identifier characteristic issecured to a second flexible suture without an identifiercharacteristic.
 10. The flexible suture of claim 9, wherein the flexiblesuture including the identifier characteristic is secured to the secondflexible suture by at least one of a knot, an adhesive, and a lockingarrangement.
 11. The flexible suture of claim 10, further comprising afirst locking end and a first aperture on the flexible suture includingthe identifier characteristic and a second locking end and a secondaperture on the second flexible suture.
 12. The flexible suture of claim11, wherein the first locking end is inserted into the second apertureand the second locking end is inserted into the first aperture, whereinwhen the strands of the flexible suture and second flexible suture aretightened, the first and second locking ends resist movement out of thefirst and second apertures.
 13. The flexible suture of claim 1, whereinthe identifier characteristic is a tracer extending from the first endof the first suture portion to the second end of the second sutureportion.
 14. The flexible suture of claim 13, wherein only a portion ofthe tracer is dyed.
 15. A flexible suture for coupling tissuecomprising: a first suture limb extending to a first end and a secondsuture limb extending to a second end; a plurality of braided strandsforming the first and second suture limbs; and a structural identifiercharacteristic formed into the plurality of braided strands of only oneof the first suture limb and the second suture limb, wherein thestructural identifier characteristic changes the shape of one of thefirst and second suture limbs and differentiates the structure of thefirst suture limb from the structure of the second suture limb.
 16. Theflexible suture of claim 15, wherein the first structural identifiercharacteristic is a preformed knot along a length of the first suturelimb.
 17. The flexible suture of claim 15, wherein the first structuralidentifier characteristic is a bifurcation on a portion of the firstsuture limb.
 18. The flexible suture of claim 15, wherein the firststructural identifier characteristic is a loop of flexible suturematerial that is attached to a location along the length of the firstsuture limb.
 19. The flexible suture of claim 15, wherein the firststructural identifier characteristic is a loop formed from the firstsuture limb, wherein the first end of the first suture limb is attachedto a portion of the first suture limb.
 20. A flexible suture forcoupling tissue comprising: a first suture limb extending to a first endand a second suture limb extending to a second end; a plurality ofbraided strands forming the first and second suture limbs; and anidentifier characteristic in only one of the first and second suturelimbs, wherein the identifier characteristic is a dyed portion in onlyone of the first and second suture limbs.
 21. The flexible suture ofclaim 20, wherein the first and second suture limbs are formed ofbraided polyethylene fibers.
 22. The flexible suture of claim 20,wherein the dyed portion includes a radiopaque dye.
 23. The flexiblesuture of claim 20, wherein the dyed portion covers the entire length ofthe first suture limb.
 24. The flexible suture of claim 20, wherein thedyed portion forms a pattern over the length of the first suture limb.25. A flexible suture for coupling tissue comprising: a first suturelimb extending to a first end and a second suture limb extending to asecond end; a plurality of braided strands forming the first and secondsuture limbs; and an identifier characteristic formed by the pluralityof braided strands in the first and second suture limbs distinguishingthe first suture limb from the second suture limb, wherein the firstsuture limb forms a first shape and the second suture limb forms asecond shape, wherein the first shape is different from the secondshape.
 26. The flexible suture of claim 25, wherein the first shape issubstantially cylindrical or flat.
 27. A flexible suture for couplingtissue comprising: a first suture section extending from a first end toa second end; a second suture section extending from a third end to afourth end; a plurality of braided strands forming the first and secondsuture sections; an identifier characteristic formed into the pluralityof braided strands, wherein the identifier characteristic extends fromone of the first end to the second end of the first suture section andthe third end to the fourth end of the second suture section, and theidentifier characteristic distinguishes the first suture limb from thesecond suture limb; and a coupler attaching the first suture section tothe second suture section.
 28. The flexible suture of claim 23, whereinthe coupler is an adhesive material that adheres the first suturesection to the second suture section.
 29. The flexible suture of claim23, wherein the coupler is a knot securing the first suture section tothe second suture section.
 30. The flexible suture of claim 23, whereinthe coupler is a locking arrangement securing the first suture sectionto the second suture section.
 31. The flexible suture of claim 26,further comprising a first aperture in the first suture section and asecond aperture in the second suture section, wherein the first andsecond apertures are formed by loosening the braided strands in portionsof the first and second suture sections.
 32. The flexible suture ofclaim 27, wherein the second end is inserted into the second apertureand the third end is inserted into the first aperture, wherein when thestrands of the first suture section and second suture section aretightened, the second and third ends resist movement out of the firstand second apertures.
 33. A flexible suture for coupling tissuecomprising: a first portion including a first visual identifier; asecond portion including a second visual identifier that is differentfrom the first visual identifier; wherein the first portion extendsthrough a loop defined by the second portion and the second portionextends through a sleeve defined by the first portion, the loop iswithin the sleeve to couple the first portion and the second portiontogether.
 34. The flexible suture of claim 33, wherein the first visualidentifier includes a first color and the second visual identifierincludes a second color that is different than the first color.
 35. Theflexible suture of claim 33, wherein the first visual identifierincludes a first tracer portion and the second visual identifierincludes a second tracer portion configured differently than the firsttracer portion.